GERD is a digestive disorder that affects the lower esophageal sphincter, which is the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the backward flow of acids from the stomach into the esophagus. Doctors believe that some people usually suffer due to a condition called hiatal hernia. Pregnant women usually suffer from heartburn or acid indigestion caused by Gastroesophageal Reflux Disease.

The primary goals in the treatment of this disease are relief from symptoms, healing of erosive esophagitis and prevention of complications of esophagitis. The symptoms include heartburn and regurgitation. The setting includes a proton pump inhibitor (PPI). Patients suspected due to GERD with non-cardiac chest pain are recommended to have diagnostic evaluation before institution of therapy. For diagnosing GERD, barium radiographs should not be used.

The other points that must be remembered to diagnose GERD are
1. Endoscopy is recommended only in case of alarming symptoms. Even in typical symptoms, the upper endoscopy is not recommended.
2. For preoperative evaluation, esophageal manometry is recommended, but it has no role in diagnosing GERD.
3. Ambulatory reflux monitoring is a test that can assess association of reflux symptoms.

Management:
The suggested lifestyle modifications for the patients with GERD are

    Weight loss is recommended for patients who are overweight. So, avoid large meals and decrease dietary fat intake.
    Avoid alcohol, chocolate, onions, garlic, acidic foods and peppermint.
    Do not lie down within 3 to 4 hours after meal (recommended for nocturnal GERD patients).
    For symptom relief and to heal erosive esophagitis, a 8-week course of PPIs is the therapy of choice.
    Medications that help in potentiating GERD symptoms, including alpha-adrenergic agonists, nitrates, calcium channel blockers and theophylline should be avoided.
    For patients without diagnostic evaluation, therapy for GERD other than acid suppression, including prokinetic therapy should not be used.
    For patients with partial response to PPI therapy, additional symptom relief can be achieved by increasing the dose twice daily or switching to a different PPI.
    It is recommended to elevate the head of the bed 10 to 20 cm.
    Avoid wearing clothes which are tight around the waist.
    If patients experience heartburn relief, Histamine-receptor antagonists (H2RA) therapy can be used as a maintenance option in patients without erosive disease.

Some surgical options
1. For long-term therapy for patients suffering with GERD, surgical therapy is the best treatment option.
2. In patients who have no evidence of erosive esophagitis, preoperative ambulatory pH monitoring in mandatory.
3. Gastric bypass is the preferred operation for patients who are suffering with obesity and are contemplating surgical therapy for GERD.

Apart from these, there are potential risks that are associated with PPIs such as switching them can be considered in setting of side effects and the therapy can be a risk factor for Clostridium difficile infection.

Management of Gastroesphageal Reflux Disease (GERD)

The only thing that can ruin a great meal is the feel of a bloated tummy afterwards! Usually any abnormal swelling or increase in diameter of the abdominal area is termed as bloating. The condition has become very common and is experienced by people around the world. Poor diet, sedentary lifestyle, high level of stress and need for daily medications seem to be making people more prone to this epidemic. It can sometimes also be a result of an underlying health issue that you might be unaware of. The good thing is that there are signs of it which can be watched out for.

What to Keep an Eye Out For: To start off, there is the sign which is considered to be rather obvious by many flatulence. If a person wants to get rid of flatulence for an extended period, he or she should consider this to be a warning.

Bloating itself can be a sign for other problems which are deeper. The prime example of this happens to be coeliac disease. A bloating of the stomach which is accompanied by pain and a puzzling loss of weight could be signs of this disease.

If a fever seems to keep recurring without a cause which is explainable, it could be a sign of bloating. As a matter of fact, this sign along with bloating also does signal some infection, which should be looked at immediately by a medical professional. Also, too much stress on a person could be a sign of impending bloating issues.

Getting Rid of Bloating: In order to cure bloating which is caused by flatulence, an easy and elementary solution is to eat your food slowly and to chew properly. In serious case, seeking adequate medical help is important.

When a person finds that he or she seems to be suffering from bloating very often, it is a good idea to maintain a food diary. This will help find whether there are certain trigger foods which cause bloating. The pattern can be discussed with your doctor and concrete steps can be taken towards a complete solution.

Simple lifestyle changes beyond the diet can also make a difference. These include correction of sleeping and eating habits of a person. You are also required to be very regular with this.

Bloating always has some signs which are associated with its causes so it makes good sense to be aware of the same as the saying goes, 'a stitch in time saves nine'!

Warning Signs of Bloating? How to Treat It?

Foods that make your stomach bloat

Do you feel your stomach bloat after meals? if you notice, this doesn't happen after every meal? only at times. And at other times when you eat specific foods. Well, there are foods cause your stomach to bloat, so the wise thing to do is to know about them and avoid them! 

Here are a few of the biggest criminals:

1. Cold drinks: yes, these carbonated drinks have numerous side effects on your health. One of them is that they bloat your tummy. Beer happens to fall in this category too.

2. Dairy products: for the lactose intolerant, dairy products are almost like poison. The intolerance can be mild, moderate of severe, but one of the symptoms is gas. You can try to limit your consumption of dairy products.

3. Apples: apples and pears are known to contain high percentage of fiber. While they are important for us and should be eaten, if is good to know that they can affect sensitive tummies. Eat bit by bit, and if it helps, peel the skin and then eat.

4. Few veggies: while they are excellent health foods, asparagus, cabbage and broccoli are vegetable which cause gas in the stomach, which in turn leads to bloating of the tummy.

5. Sodium: sodium is also another reason for bloated tummies, so it is advised to limit salt intake.
6. Fast foods: fast foods like sausages, fried foods, ice cream, sweetened products, etc are known to cause the belly to bloat.

7. Rice preparations: rice is known to swell up inside the stomach once it gets water, hence making the stomach feel bloated.

8. Hard drinks: alcohol is also said to add on weight near the stomach and make it feel bloated.


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The 8 Foods That Bloat Your Belly!

Feeling bloated or acidic after a heavy meal can take away all the satisfaction the taste of food gave you. Indigestion and gas are some of the most common gastrointestinal problems faced by people around the world. In most cases, indigestion is a result of bad food choices and unhealthy lifestyles. Thus they can simply be relieved at home and do not necessarily need medication. Here are 4 easy steps to lower heartburn, gas and indigestion.

1. Add more fiber to your food: Fiber is crucial to healthy digestion. It is easy to digest and help push waste out of the system by adding bulk. In this way, fiber helps detoxify the system as well. It also prevents diabetes, heart disease, hemorrhoids and other diseases. Add fiber to your diet in the form of whole grains, cereals, fruits, vegetables, nuts and plenty of water. Ideally, a woman should have 25gms of fiber a day and men should have 38 grams of fiber a day.

2. Healthy food eating habits: How you eat also makes a difference to your digestion. Instead of eating on the move, eat mindfully. Chew your food carefully to begin the digestive system. Eating smaller portions can also help improve stomach functioning. Avoid fast foods that are difficult to digest. Ensure that you do not eat anything for at least an hour before going to bed. Lying down immediately after a meal is one of the leading causes of indigestion.

3. Probiotics: Gut bacteria is essential for healthy digestion. This bacteria helps maintain a healthy inner ecosystem and help fight harmful viruses, yeast and other such microorganisms. This balance of gut bacteria can be affected by an unhealthy lifestyle like excessive alcohol consumption, smoking, stress and certain prescription drugs. Supplementing your natural probiotic enzymes with food rich in probiotics like yogurt or probiotic supplements can help make your digestion better.

4. Exercise Regularly: Exercise is necessary not only for a fit body but also for healthy digestion. Exercising also helps fight stress that is one of the leading causes of indigestion. Taking a walk after meals can help regulate the passage of food and gases in your digestive system. This prevents bloating and heartburn. Physical activity also helps stimulate your bowels to prevent constipation and prevent gaseous build up. Some forms of exercise you could try are yoga, swimming and cycling. A word of caution; always ensure that there is at least an hour's gap between exercising and your last meal.

Gas & Indigestion - 4 Things That Can Help Ease It!

Over the past several years, the prevalence of GERD (Gastro-oesophageal reflux disease) has increased in our communities due to unhealthy lifestyle and that can potentially lead to serious medical complications if left untreated. 

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.

However, some patients may present with atypical symptoms such as a cough, asthma, laryngitis, or chest pain, and other patients with GERD experience no symptoms at all. 

Causes

1) Eating food while not feeling hungry
2) Eating in haste and in indigestion
3) Eating stale food
4) Eating spicy, hot  & tangy, fermented, stale food on a regular basis.
5) Excess consumption of tea, coffee
6) Sleeping immediately after meals
7) Drinking alcohol & smoking in excess
8) Mental stress
9) Staying awake at night, disturbed
sleep
10) Eating late at night.

Signs and symptoms:

Difficulty in swallowing
Regurgitation of food
Belching
Bitter taste in mouth
Discomfort or pain in upper abdomen
Dry cough
Anorexia ( loss of appetite )
Excessive thirst
Heartburn especially after meals and at night
Loss of taste
Nausea & vomitting
Bloating
Giddiness
Treatment in Ayurveda focuses on:

1) Improving appetite
2) Help nourishment of body
3) Regulating the acid metabolism in the body
4) Improve the ability of digestion & absorption
5) Treat inflammation and cause healing of the digestive tracts
6) Protecting the intestinal layers from ill effects of acid 

Do's & Don'ts for GERD:

Do's

1) Eat light to digest food
2) Eat only when one is hungry
3) Gap between two meals should not be more than 6 hrs
4) Eat fruits  daily 
5) Food good for GERD - Old caged rice, Jowar roti, Moongdal, Bittergourd, pumpkin, dates, pomegranate, Indian gooseberry,  Lemon, mint, mangosteen, turmeric, coriander, cumin, asafoetida, coconut, cowghee, cow milk, fresh buttermilk .
6) Drink lukewarm water half hour after meals
7) Walk after every meal
8) Daily exercise for atleast 45 min

Dont's
1) Very spicy & hot, excessive consumption of chillies & curd
2) Excess tea, coffee & fermented food
3) Excess stress & negative thinking
4) Sedentary lifestyle
5) Excess smoking & drinking
6) Drinking excessive water 
7) Sleeping immediately after meals
8) Sleeping in the afternoon
9) Staying awake late night

Symptoms of GERD are very commonly found in the population. If it is not taken care of, it can lead to complications like Barrett's oesophagus, oesophagitis, ulcers, Ca oesophagus, bleeding, scarring and difficulty in swallowing. Ayurveda has a complete holistic approach in treating GERD. Treating on time helps in avoiding complications in future.

Gastroesophageal Reflux Disease And Ayurveda!

Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or 
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone 
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications. Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Causes It?

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